medigraphic.com
ISSN 2594-1518 (Digital)
ISSN 1405-0099 (Impreso)

2015, Número 3-4

<< Anterior Siguiente >>

Cir Gen 2015; 37 (3-4)


Reconstrucción de la vía biliar, secundaria a lesiones mayores iatrogénicas

Bonifaz CJE, Palacio VAF

Idioma: Español
Referencias bibliográficas: 53
Paginas: 70-81
Archivo PDF: 303.40 Kb.


RESUMEN

Antecedentes: La lesión de vía biliar es una de las complicaciones más temidas, peligrosas y que aumentan la morbimortalidad. Con la colecistectomía laparoscópica se incrementó la incidencia de lesión hasta que se estabilizó en un 1.3%, lo cual es aún alto para el 0.6% de la era abierta. El objetivo es mostrar la experiencia de la unidad hospitalaria en el manejo de la lesión de vía biliar en un periodo de 30 años. Material y métodos: Éste es un estudio retrospectivo, descriptivo, observacional en pacientes del Servicio de Cirugía General del Hospital Regional “General Ignacio Zaragoza” en el periodo comprendido de 1980 a 2009, con análisis de expedientes clínicos, estudios de laboratorio e imágenes de control y seguimiento de los pacientes intervenidos quirúrgicamente. Se incluyeron, solamente, individuos con lesiones mayores de vía biliar con diagnóstico trans- y postoperatorio sometidos a reconstrucción de la misma. Se intervinieron 67 sujetos, de los cuales 58 eran mujeres y nueve hombres. Resultados: El tipo de lesión más frecuente fue Bismuth III y el procedimiento quirúrgico más utilizado fue la hepaticoyeyunoanastomosis en Y de Roux, en 54 de ellos, con un 5.2% de mortalidad en los primeros 13 meses y un 89.5% de éxito en el primer año de seguimiento. Conclusiones: La incidencia de la lesión de la vía biliar durante un procedimiento quirúrgico es baja en centros de concentración y alta especialidad. Es imperativo para el cirujano conocer las alternativas diagnósticas y quirúrgicas al enfrentar este tipo de lesiones.


REFERENCIAS (EN ESTE ARTÍCULO)

  2. Bachellier P, Nakano H, Weber JC, et al. Surgical repair after bile duct and vascular injuries during laparoscopic cholecystectomy: when and how? World J Surg. 2001; 25: 1335-1345.

  3. Tsalis K, Zacharakis E, Sapidis N, et al. Complications during and after laparoscopic cholecystectomy. An audit of 1042 cases. HPB (Oxford). 2005; 7 Suppl 1: 133.

  4. De Reuver PR, Busch ORC, Rauws EA, et al. Long-term results of a primary end-to-end anastomosis in peroperative detected bile duct injury. J Gastrointest Surg. 2007; 11: 296-302.

  5. Moossa AR, Easter DW, van Sonnenberg E, et al. Laparoscopic injuries to the bile duct. A cause for concern. Ann Surg.1992; 215: 203-208.

  6. Bergman JJ, van den Brink GR, Rauws EA, et al. Treatment of bile duct lesions after laparoscopic cholecystectomy. Gut. 1996; 38: 141-147.

  7. Richardson MC, Bell G, Fullarton GM. Incidence and nature of bile duct injuries following laparoscopic cholecystectomy: an audit of 5913 cases. Br J Surg. 1996; 83: 1360-1365.

  8. Nuzzo G, Giuliante F, Giovannini I, et al. Bile duct injury during laparoscopic cholecystectomy: results of an Italian national survey on 56 591 cholecystectomies. Arch Surg. 2005; 140: 986-992.

  9. Gouma DJ, Obertop H. Management of bile duct injuries: treatment and long-term results. Dig Surg. 2002; 19: 117-122.

  10. Krahenbühl L, Sclabas G, Wente MN, et al. Incidence, risk factors, and prevention of biliary tract injuries during laparoscopic cholecystectomy in Switzerland. World J Surg. 2001; 25: 1325-1330.

  11. Walsh RM, Vogt DP, Ponsky JL, et al. Management of failed biliary repairs for major bile duct injuries after laparoscopic cholecystectomy. J Am Coll Surg. 2004; 199: 192-197.

  12. Bruce E, Stabile MD. Laparoscopic cholecystectomy associated bile duct injuries. WJM. 1998; 168: 41.

  13. Johnston GW. Iatrogenic bile duct stricture: an avoidable surgical hazard? Br J Surg. 1986; 73: 245-247.

  14. Smith EB. Iatrogenic injuries to extra hepatic ducts and associated vessels: a twenty-five year analysis. J Natl Med Assoc. 1982; 74: 735-738.

  15. Keulemans YC, Bergman JJ, de Wit LT, et al. Improvement in the management of bile duct injuries? J Am Coll Surg. 1998; 187: 246-254.

  16. Buell JF, Cronin DC, Funaki B, et al. Devastating and fatal complications associated with combined vascular and bile duct injuries during cholecystectomy. Arch Surg. 2002; 137: 703-710.

  17. Way LW, Stewart L, Gantert W, et al. Causes and prevention of laparoscopic bile duct injuries analysis of 252 cases from a human factors and cognitive psychology perspective. Ann Surg. 2003; 237: 460-469.

  18. Bektas H, Schrem H, Winny M, et al. Surgical treatment and outcome of iatrogenic bile duct lesions after cholecystectomy and the impact of different clinical classification systems. Br J Surg. 2007; 94: 1119-1127.

  19. Neuhaus P, Schmidt SC, Hintze RE, et al. Classification treatment of bile duct injuries after laparoscopic cholecystectomy. Chirurg. 2000; 71: 166-173.

  20. Siewert JR, Ungeheuer A, Feussner H. Bile duct lesions in laparoscopic cholecystectomy. Chirurg. 1994; 65: 748-757.

  21. Alves A, Farges O, Nicolet J, et al. Incidence and consequence of an hepatic artery injury in patients with postcholecystectomy bile duct strictures. Ann Surg. 2003; 238: 93-96.

  22. De Santibáñes E, Ardiles V, Pekolj J. Complex bile duct injuries: management. HPB (Oxford). 2008; 10: 4-12.

  23. Babel N, Sakpal SV, Paragi P, et al. Iatrogenic bile duct injury associated with anomalies of the right hepatic sectoral ducts: a misunderstood and underappreciated problem. HPB Surg. 2009; 2009: 153269.

  24. Colovic RB. Isolated segmental, sectoral and right hepatic bile duct injuries. World J Gastroenterol. 2009; 15: 1415-1419.

  25. Fragulidis G, Marinis A, Polydorou A, et al. Managing injuries of hepatic duct confluence variants after major hepatobiliary surgery: an algorithmic approach. World J Gastroenterol. 2008; 14: 3049-3053.

  26. Ayuso JR, Ayuso C, Bombuy E, et al. Preoperative evaluation of biliary anatomy in adult live liver donors with volumetric mangafodipir trisodium enhanced magnetic resonance cholangiography. Liver Transpl. 2004; 10: 1391-1397.

  27. Strasberg SM, Hertl M, Soper NJ. An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg. 1995; 180: 101-125.

  28. Archer SB, Brown DW, Smith CD, et al. Bile duct injury during laparoscopic cholecystectomy: results of a national survey. Ann Surg. 2001; 234: 549-559.

  29. Tay KH. Laparoscopic cholecystectomy: an audit of our training programme in Singapore. HPB (Oxford). 2005; 7 Suppl 1: 136.

  30. Smith EB. Complications of laparoscopic cholecystectomy. J Natl Med Assoc. 1992; 84: 880-882.

  31. De Reuver PR, Grossmann I, Busch OR, et al. Referral pattern and timing of repair are risk factors for complications after reconstructive surgery for bile duct injury. Ann Surg. 2007; 245: 763-770.

  32. Sicklick JK, Camp MS, Lillemoe KD, et al. Surgical management of bile duct injuries sustained during laparoscopic cholecystectomy: perioperative results in 200 patients. Ann Surg. 2005; 241: 786-792; discussion 793-795.

  33. Bismuth H, Majno PE. Biliary strictures: classification based on the principles of surgical treatment. World J Surg. 2001; 25: 1241-1244.

  34. Chaudhary A, Chandra A, Negi SS, et al. Reoperative surgery for postcholecystectomy bile duct injuries. Dig Surg. 2002; 19: 22-27.

  35. Jablonska B, Lampe P. Iatrogenic bile duct injuries: etiology, diagnosis and management. World J Gastroenterol. 2009; 15: 4097-4104.

  36. Tocchi A, Mazzoni G, Liotta G, et al. Late development of bile duct cancer in patients who had biliary-enteric drainage for benign disease: a follow-up study of more than 1,000 patients. Ann Surg. 2001; 234: 210-214.

  37. Fischer CP, Fahy BN, Aloia TA, et al. Timing of referral impacts surgical outcomes in patients undergoing repair of bile duct injuries. HPB (Oxford). 2009; 11: 32-37.

  38. Lillemoe KD, Melton GB, Cameron JL, et al. Postoperative bile duct strictures: management and outcomes in the 1990s. Ann Surg. 2000; 232: 430-441.

  39. Lillemoe KD, Martin SA, Cameron JL, et al. Major bile duct injuries during laparoscopic cholecystectomy. Follow-up after combined surgical and radiologic management. Ann Surg. 1997; 225: 459-471.

  40. Mercado MA, Chan C, Orozco H, et al. To stent or not to stent bilioenteric anastomosis after iatrogenic injury: a dilemma not answered? Arch Surg. 2002; 137: 60-63.

  41. Hall JG, Pappas TN. Current management of biliary strictures. J Gastrointest Surg. 2004; 8: 1098-1110.

  42. Ahrendt SA, Pitt HA. Surgical therapy of iatrogenic lesions of biliary tract. World J Surg. 2001; 25: 1360-1365.

  43. Johnson SR, Koehler A, Pennington LK, et al. Long-term results of surgical repair of bile duct injuries following laparoscopic cholecystectomy. Surgery. 2000; 128: 668-677.

  44. Tocchi A, Costa G, Lepre L, et al. The long-term outcome of hepaticojejunostomy in the treatment of benign bile duct strictures. Ann Surg. 1996; 224: 162-167.

  45. Terblanche J, Worthley CS, Spence RA, et al. High or low hepaticojejunostomy for bile duct strictures? Surgery. 1990; 108: 828-834.

  46. Boerma D, Rauws EA, Keulemans YC, et al. Impaired quality of life 5 years after bile duct injury during laparoscopic cholecystectomy: a prospective analysis. Ann Surg. 2001; 234: 750-757.

  47. De Reuver PR, Sprangers MA, Gouma DJ. Quality of life in bile duct injury patients. Ann Surg. 2007; 246 :161-163.

  48. Andersson R, Eriksson K, Blind PJ, et al. Iatrogenic bile duct injury —a cost analysis. HPB (Oxford). 2008; 10: 416-419.

  49. Savader SJ, Lillemoe KD, Prescott CA, et al. Laparoscopic cholecystectomy-related bile duct injuries: a health and financial disaster. Ann Surg. 1997; 225: 268-273.

  50. Chow SC, Sahajpal AK, Dixon E, et al. Bile duct injuries associated with laparoscopic cholecystectomy: timing of repair determines long-term outcomes. Can J Surg. 2008; 51 Suppl: 42.

  51. Silva MA, Coldham C, Mayer AD, et al. Specialist outreach service for on-table repair of iatrogenic bile duct injuries —a new kind of “travelling surgeon”. Ann R Coll Surg Engl. 2008; 90: 243-246.

  52. Pekolj J. Manejo de las complicaciones más frecuentes de la cirugía abdominal. Rev Arg Cirg. 2003 [Número extraordinario].

  53. De Santibañés E, Sivori J, Pekolj J, et al. Lesiones de la vía biliar secundaria a colecistectomía laparoscópica. Rev Arg Cirg. 1996; 70: 208-219.




2020     |     www.medigraphic.com